Seeing Beyond the Illness to the Person:
The Recovery Approach and Community Mental Health
COTA Health provides community-based rehabilitation and mental health services to over 36,000 clients in Ontario every year. Nearly 800 employees and volunteers help individuals to live their best by delivering services within the organization's values of being client-centred, dedicated, innovative and collaborative. As Vice President of Mental Health & Community Support Services, Paul Bruce is a guardian of these values. He recognises that how they are implemented will change over time and has been interested in one particular influence of change on the 'client-centred' value: the recovery approach to mental illness.
Recent studies such as the 2002 Toronto-Peel Mental Health Implementation Task Force report entitled "The Time has Come: Make it Happen", and the 2007 Kirby Report entitled "Out of the Shadows at Last" point to the value of the recovery approach to mental illness. While being client-centred, "our services have been more about making sure the person is on the appropriate medication than engaging with them about their life and looking beyond the limitations they may be facing due to mental illness," says Paul. "In my mind, there is a big gap between doing things on behalf of people and engaging the person, considering their hopes and aspirations for the future and supporting them to move in that direction. I wanted to shift the focus of our mental health services to be more inclusive of recovery concepts and principles."
The Mental Health and Community Support Services division is dedicated to supporting individuals living with mental health challenges, acquired brain injury, developmental disabilities and dual diagnosis. Its services include case management, supportive housing, day programs, court and justice related services and outreach for individuals who are homeless or living in shelters. To integrate new concepts into an organization of this size requires a concerted effort. COTA Health turned to Christine Gayler for support.
Christine joined the initiative in the fall of 2006. She began by exploring with Paul his objectives for the project and ways in which the first wave of change could be activated across the organization. It was determined that a series of modules in which the staff could participate would be an effective approach.
With the task of helping the service providers see their practices through a recovery lens, Christine met with various teams to understand the existing culture and decide what the modules would look like. From December 2006 to June 2007, those modules were rolled out and staff from across the organization participated. The modules were repeated at different times and in different locations in hopes of accommodating as many people as possible. The participants learned, discussed, completed reflective exercises and took on homework tasks in an effort to integrate the concepts of recovery into their mindsets and practices.
In the summer, Christine summarized the initiative into a final report that included the purpose and intent of the project, a description of the process, collated feedback and results. She presented the report to the divisional team, senior management and the mental health advisory committee and provided recommendations for them to consider for Phase II of the process of integrating the recovery approach into COTA Health.
"We are now at the cusp of taking Christine's recommendations along with our own ideas and hosting a recovery event in December to celebrate internally what has been achieved so far and recognize the staff that completed the modules. We want to hear from the teams that have integrated recovery into their practices and we want to hear from consumers who want to share their stories."
Paul is now taking the time to consider next steps and how to build on the momentum that was created with Christine's help. "What I wanted was for the light bulb to go on - and it did. I brought Christine in to help us build an awareness and mindset for recovery and start the momentum we would need for a cultural shift to the recovery approach. Christine was able to engage people and help make that happen."